2. Introductions to EHB’s
 Section 1302 of ACA
 Ensures that plans offered in individual and small
group markets have a comprehensive package of
covered services available to them
 Plans established after 2014 must contain:
 The 10 EHB’s
 A cost-sharing limit
 Either bronze, silver, gold or platinum level coverage

3. The Essential Health Benefits
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance abuse disorder services,
including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventative and wellness services and chronic disease
management
10. Pediatric services, including oral and vision care

4. Cost Sharing
 Annual limitation on cost sharing
 the sum of the annual deductible and the other annual out-
of-pocket expenses required to be paid under the plan (other
than for premiums) for covered benefits does not exceed—
 $5,000 for self coverage
 Twice the amount above for family coverage
 Annual limitation on deductibles for employer sponsored
plans
 In the case of a small group market, the deductible shall not
exceed $2,000 for an individual or $4,000 in the case of any
other plan
Amounts are adjusted annually based on the percent
increase in average premiums per person for health
insurance coverage

5. Cost Sharing Tiers
 Enrollees must have at least bronze level coverage
 These tiers pay for a certain percent of covered benefits
 Bronze- 60%
 Silver- 70%
 Gold- 80%
 Platinum- 90%
 EX. If a patient had a silver plan they would have about 70% of their
bill covered but would have to pay the remaining 30% through
means such as deductibles, copayments and coinsurance
 As the plans go down from platinum to bronze the monthly
payments also decrease from tier to tier
 In order to receive tax credits and cost sharing reductions
one must have at least silver level coverage

6. Sec. 1302 (b)(2)(B)
 This provision states that the essential health benefits
must be refined to eliminate any gaps in EHB’s and the
Secretary must provide an opportunity for public
comment
 So the public submitted their comments,
recommendations and disagreements…

7. What We Have Been Doing
 Organizations, individuals and coalitions have
submitted their recommendations to improve EHB’s
 Two researchers read the letters sent in
 Both researchers coded the letters into about thirty
categories (AKA nodes)
 10 EHB’s along with other components of the provision
(cost-sharing, quality improvement, benchmark plans,
etc…)
 We found the coefficient of overlap between what the
two researchers coded into specific nodes

8. What we found… So Far
 The Benchmark plan node was one of most referenced
nodes
 We had a .777 Kappa coefficient between us
 Our agreement level is high enough for this node to
accept the recommendations in this node
Kappa Value Interpretation
Below 0.40 Poor Agreement
0.40-0.75 Fair to good agreement
Over 0.75 Excellent agreement

9. Takeaways for Benchmark Plans
 We had 16 sources recommend changes for benchmark
plans
 The most offered recommendations:
 General consensus for support of 2017 benchmark plans
being based off 2014 plans
 7 letters want plans implemented in 2016, not 2017
 Majority want HHS to enforce the long-standing policy
that state benefit mandates enacted after December 31,
2011 must be paid for by the states

10. Next Steps
 Write a longer report detailing what the most
recommended ideas were
 Each of the top 13 nodes have about a one page summary
on them, followed by shorter bullets and paragraphs
about the less mentioned nodes
 Using the longer report, write a condensed report on
the key recommendations that were found to modify
EHB’s
 Eventually, this report will be shared with Congress on
what the public feels needs to be revised with EHB’s